Industries / Insurance

Claims Fraud

Prevent fraud before claims are paid

Most insurers have implemented sophisticated computer systems to identify fraud as soon as possible after it occurs, and they factor these losses into their rates as a cost of doing business. Recovery of losses after the fact is slow, if it happens at all. What about preventing fraud before it happens? It is estimated that 10 percent of all claims are fraudulent and that less than 20 percent of those fraudulent claims are detected or denied. Clearly, there's room for improvement that could mean millions to hundreds of millions of dollars in savings.

How SAS® Can Help 

Proactively uncovering fraudulent claims requires extensive data gathering and analysis, but such information is often difficult and time-consuming to obtain. With SAS, you can:

  • Enhance information credibility by integrating disparate data sources and applying embedded data quality techniques.
  • Find fraud before claims are paid using a hybrid of business rules, predictive analytics and social network analysis technology.
  • Reduce false positives with a sophisticated fraud scoring engine.
  • Improve investigator efficiency with advanced case management tools.
  • Measure program performance by defining and monitoring key performance metrics.

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How SAS® Is Different 

Only SAS delivers a proven foundation along with best practices that tie together all the essential areas of claims fraud detection and prevention. SAS provides:

  • Detection and alert generation.
  • Alert management functionality.
  • Social network analysis.
  • Case management capabilities.

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Related Products and Solutions

SAS® Fraud Framework for Insurance

Fraud costs the P&C industry $30 billion each year in the US alone, and that figure is projected to rise as both opportunistic and professional fraud continue to grow. It is estimated that more than 10 percent of all insurance claims are fraudulent, but insurers often accept fraud as a cost of doing business since it isn't cost-effective to pursue fraudulent claims after settlement. That's why SAS developed the SAS Fraud Framework for Insurance, an end-to-end solution for preventing, detecting and managing claims fraud across the various lines of business within today's insurers.

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SAS® Enterprise Case Management

SAS Enterprise Case Management enables investigators and operational risk managers in a variety of industries – banking, insurance, government, health care, etc. – to streamline processes and conduct more efficient, effective investigations, leading to reduced costs and better fraud prevention. The solution provides a structured environment for managing investigation workflows, attaching comments or documentation and recording financial information, such as exposures and losses.

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Ready to learn more?

Call us at 1-800-727-0025 (US and Canada) or request more information.